“Modicare” – A colossal blunder waiting to happen

A prediction of what to come from past experiences

By now everyone is aware of the fact in our current cashless medical scheme has been introduced by the government that will cover 10 crore poor families covering up to a maximum of 5 lakhs per family (not individuals). From the intentions of the government this is a great scheme. However, the experience has shown otherwise.

Undiscerning Patients

Most the patients are new to the bigger hospital, so they now want to go to these hospitals no matter what. They will start going to the hospital for sneeze or a cough. They might even go to hospitals to take bed rest in those air-conditioned rooms as the temperatures in Indian summer increase.

This did happen in Aarogyasri scheme run by government of then combined State of Andhra Pradesh, between 2005 and 2010. You can read the full article here

Unscrupulous Doctors

Many have seen the Satyameva Jayate, Season 1, Episode 4 on medical malpractice. We have seen the doctor removing the uterus. Why do you think that is? That is done in the combined state of Andhra Pradesh during the implementation of Aarogyasri. Usually the patients couldn’t have afforded such an operation. But since it is free, they went ahead without much thought process. This was also a cashless scheme.

One of my friend had an accident recently, resulting in a fractured hand, the x-rays showed the fracture but there was no dislocation. Her husband, being a husband and in deep love took her to the biggest hospital in Hyderabad. The ER doctor immediately suggested that there is a need for surgery, by the way the bill was ₹3,00,000. The husband, informed the ER doctor about her being a kidney transplant patient and still on medication would be very risky, but ER doctor still insisted on going ahead. Only because we had previous experience with fractures, we came out and had a cast at a cost of ₹3,000 (still costly by some standards) and within 45 days had the hand fixed. It is more than about the money. ₹3,00,000 is not burdensome to this family, but the doctor’s insistence on going ahead with surgery when it was not necessary, a doctor’s willingness to cut people up just for money, without taking patients health into consideration, a doctor’s brazenness to put the patient’s life risk for whatever monetary benefit he is getting, is just something most of these families being newly insured will not be prepared for, or experienced enough to make a decision.

Even Good Intentions

Sometimes it is not just the unscrupulous ones, even good intentions can be bad financially. For example, another friend of mine had an accident which lead to a head injury. As a precaution MRI was taken. Good. But the doctor insisted a regular monthly MRI. By the way each MRI is ₹27,000 (at that hospital). It is not unwise to have a regular checkup in case of a head injury, but it need not be always with an MRI. Tests like walking in a straight line, counting fingers can be conducted regularly to diagnose on a regular basis. But big hospitals have a thing for modern equipment and shun traditional diagnosis that has been in the field before the machines came.

Out of Work Neighbourhood Doctors

Most of the neighbourhood doctors are in business because their patients cannot afford a big hospital. With the implementation of this new insurance scheme most if not all will be out of business. Most of these doctors are just next door or walking distance away to most the those being insured now. All the insure would want to go the bigger hospitals making these neighbourhood doctors financially worse off.

Lack of Doctors

According to a recent article in Indian Express, India has 6 doctors for every 10,000. The world average is 15 doctors for every 10000 (in 2012 according to World Data). But some countries considered really good at health care like Cuba have 59 doctors for every 10000 population(source: website, accessed on 06/02/2018). We are ranked below Iraq and above Laos, not exactly a good place to be. This is especially the case when many states are touting themselves as medical tourist hotspots.

Lack of Distribution

Most multi-specialty hospitals have a habit concentrating themselves in the major cities. Government cannot solve this problem if it only gives the cashless scheme to the big corporate hospitals in the metros. They should make sure that the rural villagers can visit a hospital within a radius of 30 kilometers at the most. Under scheme give the cashless option to these remote and non-corporate hospitals.

Some Solutions

Deductibles

So, there are problems, it is not like there are no solutions. One of the ways the western and even Indian insurance companies have solved many of the above problems are by having deductibles. Indian government under the new scheme can insist that the patients should pay the ₹5,000 for every bill. This will bring down number of visits and limits to genuine problems.

Prevention is Better than Cure

Since the government is footing the bill of the millions (500 million to quote the sources), it can insist on prevention. This prevention can be free of cost visits to your neighbourhood doctors/RMPs, with the government keeping the master data on records. One this will increase the chances of diagnosing the diseases at an early date and reduce the bill to the government. It will also deter the major hospitals doing unscrupulous operations. Those who fail to have regular checkup should have their deductibles increased to ₹10,000. This method also keeps the neighbourhood doctor employed.

Government Ownership of Medical Records

Ownership of the medical records should belong to the Government not the Hospitals. Keeping every medical record connected to Aadhaar will allow the easy flow of data especially for migrant workers, so that the new doctor can take up from where the previous doctor has left. Otherwise, most hospitals insist on running full tests on every visit. Insist on every test and every prescription being uploaded to government records. This way, even if they prescribe non-generic medicine the government knows on whose payroll the doctors are.

Disclaimer : Views expressed are authors personal opinion and are not against government, government schemes, doctors. Author has high regards for doctors and services they are rendering to humanity.
About the author: https://www.linkedin.com/in/ca-raja-boppana-7200898/